Organ Donation and Transplantation after Cardiac Death

With the success of organ transplantation and the declining number of heart beating cadaver donors, the number of patients awaiting a transplant continues to rise. This means that alternative sources of donors have been sought, including donors after cardiac death. Such donors sustain rapid damage to their organs due to ischaemia, and as a consequence some organs do not work initially and some none at all. The proportion of such transplants has increased dramatically in recent years- 25% of kidney transplants in the UK were from such donors in 2006 highlighting how much progress has been made. Written by international experts, this book lays out the moral, legal and ethical restraints to using such donors for organ transplant together with the techniques that have been adopted to improve their outcome. The different approaches and results of renal transplant according to country are covered together with the procedures and outcomes adopted to use other organs, notably the liver and lungs.

1. History of non heart beating donation. 2. The legal and moral issues of non heart beating donation. 3. The history of organ perfusion in organ transplantation. 4. Viability testing of kidneys from non heart beating donors. 5. Perfusate development for the non heart beating donor. 6. Thrombolysis in the non heart beating donor. 7. Supplemental cryo-preservation of the donor by peritoneal cooling. 8. Gaseous oxygen to improve viability of marginal or pre-damaged organ grafts during hypothermic storage. 9. ECMO in non heart beating donation: Michigan technique. 10. Renal recipient selection and management after transplant. 11. The renal biopsy in non heart beating organ transplantation. 12. Early results for renal transplants from non heart beating donors. 13. Liver transplantation using non heart beating donors. 14. Lung transplantation from non heart beating donors. 15. Donors without a heart beat in the United States. 16. Non heart beating donation in Europe. 17. Renal and islet transplantation from non heart beating donors in Japan. 18. The current situation and further development.

David Talbot has been a transplant surgeon in Newcastle since 1995 having trained in the north east of England and Birmingham. His early research interests were antibody detection using flow cytometry and later mainly non heart beating donation. His current clinical practice includes access surgery, renal and liver transplantation, live donor and paediatric renal transplantation. Dr. D'Alessandro received his BS from Gannon University in 1976 and his MD from Hahnemann University in 1981. He continued his education as a resident in surgery, research fellow, and transplant fellow at the University of Wisconsin. Dr. D'Alessandro is Professor of Surgery, Director of Multiorgan Transplantation, Director of Pediatric Liver Transplantation, and Executive Director of the Organ Procurement Organization at the University of Wisconsin. Dr. D'Alessandro is board certified in Surgery and Surgical Critical Care. His research in the field of transplantation has resulted in over 200 publications in such journals as Transplantation, Transplantation Proceedings, Transplantation Reviews, Surgery, and Annals of Surgery. Dr. D'Alessandro's research focuses on liver and small bowel preservation for transplantation.